title: Comparison of the impact of short (<1 year) and long-term (> or =1 year) clopidogrel use following percutaneous coronary intervention on mortality.
abstract: The optimal duration of clopidogrel administration after percutaneous coronary intervention (PCI) remains unknown. Clopidogrel is currently recommended for minimums of 1 and 12 months after bare-metal stent and drug-eluting stent implantation, respectively. To determine the impact of clopidogrel discontinuation 1 year after PCI, the outcomes of 530 consecutive patients who underwent PCI from January 2004 to July 2006, were free of cardiovascular events for 6 months after PCI, and had follow-up available for >12 months were examined. The outcomes of patients who received clopidogrel for > or =1 year were compared with those of patients who received it for <1 year. The mean age was 65 +/- 9 years. Patients often presented with acute coronary syndromes (57%), and 85% received drug-eluting stents. Clopidogrel was used for > or =1 year and for <1 year in 341 and 189 patients, respectively. During a mean follow-up period of 2.4 +/- 0.8 years, 40 patients (8%) died, 21 (4%) had acute myocardial infarctions, and 89 (17%) underwent repeat coronary revascularization. Compared with patients with clopidogrel administration for <1 year after PCI, those who received clopidogrel for > or =1 year had lower mortality (14.8% vs 3.5%, p <0.001). On multivariate analysis, clopidogrel use for > or =1 year was associated with lower mortality (hazard ratio 0.28, 95% confidence interval 0.14 to 0.59), independent of traditional cardiovascular risk factors, clinical presentation, and the use of drug-eluting stents. In conclusion, the use of clopidogrel for > or =1 year after PCI was associated with lower mortality.
authors.affiliation: Dallas VA Medical Center, Dallas, Texas, USA. subhash.banerjee@utsouthwestern.edu
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Cyril
authors.initials: C
authors.lastname: Varghese
authors.forename: Jepsin
authors.initials: J
authors.lastname: Samuel
authors.forename: Rick A
authors.initials: RA
authors.lastname: Weideman
authors.forename: Bertis B
authors.initials: BB
authors.lastname: Little
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kelly
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Robert F
authors.initials: RF
authors.lastname: Reilly
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine